An analysis of integrated health care for Internet Use Disorders in adolescents and adults

Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients’ compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization

Treatment outcomes of a CBT-based group intervention for adolescents with internet use disorders

Background and aims: Instances of Internet use disorders (IUD) including Internet gaming disorder (IGD) and non-gaming pathological Internet use (ng-PIU) have the extent that they are now a growing mental health issue. Individuals suffering from IUD show a large range of symptoms, high comorbidities and impairments in different areas of life. To date there is a lack of efficient and evidence-based treatment programs for such adolescents. The present registered single-arm trial (ClinicalTrials.gov: NCT03582839) aimed to investigate the long-term effects of a brief manualized cognitive behavioral therapy (CBT) program for adolescents with IUD. Methods: N = 54 patients (16.7% female), aged 9–19 years (M = 13.48, SD = 1.72) received the CBT group program PROTECT+. IUD symptom severity (primary outcome variable) as well as comorbid symptoms, risk-related variables and potentially protective skills (secondary outcome variables) were assessed at pretest, posttest, as well as 4 and 12 months after admission. Results: Patients showed a significant reduction in IUD symptom severity at the 12-month follow-up. Effect sizes were medium to large depending on the measure. Beyond the statistical significance, the clinical significance was confirmed using the reliable change index. Secondary outcome variables showed a significant reduction in self-reported depression, social anxiety, performance anxiety and school anxiety as well as in parental-reported general psychopathology. Discussion and conclusions: The present study shows long-term effects of a manual-based CBT treatment for adolescents suffering from IUD. The results indicate that even a 4-session brief intervention can achieve a medium to large effect over 12 months. Future work is needed to confirm the efficacy within a randomized controlled trial (RCT)

Auch Du Hast Sommerferien.

Das Sommertherapiecamp (STC) ist ein multimodaler kognitiv-verhaltenstherapeutischer Intensivbehandlungsansatz für die Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörung (ADHS). Der Artikel berichtet über Befunde einer Wirksamkeitsstudie für das STC mit Prä-Post-Design und Kontrollgruppenvergleich. Die Eltern von N = 31 Kindern (7 – 11 Jahre) mit einer ADHS-Diagnose füllten vor und nach dem dreiwöchigen STC folgende Symptom-Fragebögen aus: CBCL/4 – 18, DISYPS-II FBB-ADHS und FBB-SSV. N = 13 weitere Kinder der gleichen Grundgesamtheit, die in der selben Zeit unbehandelt blieben oder „treatment as usual“ erhielten, dienten als Kontrollgruppe. Die STC-Gruppe zeigte eine Verbesserung der ADHS-Symptomatik sowie eine Reduktion weiterer Verhaltensauffälligkeiten, während vergleichbare Effekte für die Kontrollgruppe nicht nachweisbar waren. Angesichts kleiner Stichproben sind diese Befunde vorerst vorsichtig zu interpretieren, liefern jedoch erste ermutigende Hinweise auf die Brauchbarkeit des STC

Estimated prevalence of unreported IGD cases in routine outpatient children and adolescent psychotherapy

Internet Gaming Disorder (IGD) has been included in the DSM-5 as a diagnosis for further study, and Gaming Disorder as a new diagnosis in the ICD-11. Nonetheless, little is known about the clinical prevalence of IGD in children and adolescents. Additionally, it is unclear if patients with IGD are already identified in routine psychotherapy, using the ICD-10 diagnosis F 63.8 (recommended classification of IGD in ICD-10). This study investigated N = 358 children and adolescents (self and parental rating) of an outpatient psychotherapy centre in Germany using the Video Game Dependency Scale. According to self-report 4.0% of the 11- to 17-year-old patients met criteria for a tentative IGD diagnosis and 14.0% according to the parental report. Of the 5- to 10-year-old patients, 4.1% were diagnosed with tentative IGD according to parental report. Patients meeting IGD criteria were most frequently diagnosed with hyperkinetic disorders, followed by anxiety disorders, F 63.8, conduct disorders, mood disorders and obsessive-compulsive disorders (descending order) as primary clinical diagnoses. Consequently, this study indicates that a significant amount of the clinical population presents IGD. Meaning, appropriate diagnostics should be included in routine psychological diagnostics in order to avoid “hidden” cases of IGD in the future

Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Although&lt;b&gt;&lt;i&gt;&lt;/i&gt;&lt;/b&gt; social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia Psychotherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and psychodynamic therapy (PDT) compared to a waiting list (WL) in these patients. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; In a multicenter randomized controlled superiority trial, 107 patients, aged 14–20 years, were randomized to CBT (&lt;i&gt;n&lt;/i&gt; = 34), PDT (&lt;i&gt;n&lt;/i&gt; = 34), or WL (&lt;i&gt;n&lt;/i&gt; = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Both treatments were superior to WL in the LSAS-CA (CBT: &lt;i&gt;p&lt;/i&gt; = 0.0112, &lt;i&gt;d&lt;/i&gt; = 0.61, 95% CI 0.14–1.08; PDT: &lt;i&gt;p&lt;/i&gt; = 0.0261, &lt;i&gt;d&lt;/i&gt; = 0.53, 95% CI 0.06–1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: &lt;i&gt;p&lt;/i&gt; = 0.0009, &lt;i&gt;h&lt;/i&gt; = 1.0; PDT: &lt;i&gt;p&lt;/i&gt; = 0.0135, &lt;i&gt;h&lt;/i&gt; = 0.74), response (CBT: &lt;i&gt;p&lt;/i&gt; = 0.0004, &lt;i&gt;h&lt;/i&gt; = 0.97; PDT: &lt;i&gt;p&lt;/i&gt; = 0.0056, &lt;i&gt;h&lt;/i&gt; = 0.72), and the SPAI (CBT: &lt;i&gt;p&lt;/i&gt; = 0.0021, &lt;i&gt;d&lt;/i&gt; = 0.75, 95% CI 0.27–1.22; PDT: &lt;i&gt;p&lt;/i&gt; = 0.0060, &lt;i&gt;d&lt;/i&gt; = 0.66, 95% CI 0.19–1.13). Treatment effects were stable at 6- and 12-month follow-ups. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; These results are comparable to the large SOPHO-NET trial in adults (&lt;i&gt;n&lt;/i&gt; = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.</jats:p